4d flow imaging for anatomic lesions - nasci flow for anatomic leisons... · lpch stanford...
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![Page 1: 4D Flow Imaging for Anatomic Lesions - NASCI Flow for Anatomic Leisons... · LPCH Stanford University 4D Flow Imaging for Anatomic Lesions Albert Hsiao, MD, PhD Fellow, Interventional](https://reader031.vdocuments.mx/reader031/viewer/2022022421/5a89ebbb7f8b9a4a268ba10a/html5/thumbnails/1.jpg)
LPCH Stanford University
4D Flow Imaging for Anatomic Lesions
Albert Hsiao, MD, PhD
Fellow, Interventional Radiology Department of Radiology
Stanford University
LPCH Stanford University
Translating 4D Phase-Contrast MRI from Curiosity to Clinical Practice
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Disclosures
� Founder, Morpheus Medical
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Introduction � Congenital heart MRI examination
� SSFP, 2DPC, MRA � Labor-intensive, technically-demanding exam
4D Flow for Anatomic Lesions
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� 4D phase-contrast (4DPC, 4D Flow) MRI � Volumetric, time-resolved vector field
Visualization Approaches
4D Flow for Anatomic Lesions
Markl, et al. JCVMR 2011 13:7
15-30 min, limited FOV acquisition
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Parallel-imaging with compressed-sensing
Compressed-Sensing ARC/GRAPPA
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
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� Improved image quality for the same acquisition time. � 1.5T
Parallel-imaging with compressed-sensing
Compressed-Sensing ARC/GRAPPA
MPR
Vo
lum
e-re
nder
ing
4D Flow for Anatomic Lesions
10 minute, 1-mm3 near-isotropic
full FOV acquisition
Hsiao, et al. Radiology 2012 Aug 24.
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� 4D phase-contrast (4DPC, 4D Flow) MRI � Volumetric, time-resolved vector field
Compressed-sensing facilitates volumetric visualization
4D Flow for Anatomic Lesions
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Valvular insufficiency Velocity-overlay volume-rendering
PulmonicAortic
Tricuspid Mitral
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
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Valvular insufficiency Interobserver agreement
� Very high agreement between observers � Slightly greater sensitivity of second observer
present absent
present 23 1
absent 5 94
Obs
erve
r 1
Observer 2
κ=0.87
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
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Valvular insufficiency Intermodality agreement
present absent
present 21 3
absent 7 92
Obs
erve
r 1
ECHO ≥mild
present absent
present 23 5
absent 5 90
Obs
erve
r 2
ECHO ≥mild
present absent
present 14 10
absent 0 99
Obs
erve
r 1
ECHO >mild
present absent
present 14 14
absent 0 95
Obs
erve
r 2
ECHO >mild
κ=0.77
κ=0.69 κ=0.76
κ=0.61
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
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Intracardiac shunts ASD
Hsiao, et al. Radiology 2012 Aug 24.
4D Flow for Anatomic Lesions
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Intracardiac shunts VSD
Hsiao, et al. Radiology 2012 Aug 24.
4D Flow for Anatomic Lesions
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Intracardiac shunts VSD patch leak
10 year-old boy with pulmonary atresia with VSD, post-repair. Hsiao, et al. Radiology 2012 Aug 24.
4D Flow for Anatomic Lesions
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Intracardiac shunts Intraventricular aortic baffle leak
3 year-old girl with dextrocardia, cc-TGA, DORV post-Rastelli and hemi-Mustard atrial switch.
Hsiao, et al. Radiology 2012 Aug 24.
4D Flow for Anatomic Lesions
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Intracardiac shunts 1.5-Ventricle Repair
4D Flow for Anatomic Lesions
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Intracardiac shunts 1.5-Ventricle Repair
1.5-ventricle repair with VSD patch leak
4D Flow for Anatomic Lesions
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Intracardiac shunts Left atrial baffle leak
TGA
4D Flow for Anatomic Lesions
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Extracardiac shunts PAPVR
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
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Summary
� 4D Phase-Contrast (4D Flow) MRI � Can be performed as a single accelerated 10 minute
acquisition. � Facilitates visualization of anatomic lesions. � Facilitates quantitative assessment of blood flow. � Facilitates quantitative assessment of ventricular
size and function.
4D Flow for Anatomic Lesions
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Acknowledgements
� NVIDIA � Lucas Foundation � Morgridge Foundation � GE Healthcare � NIH R01 EB009690
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Thank you